A nurse is caring for an older adult patient during the immediate postoperative period after a total hip replacement. The surgeon has ordered meperidine (Demerol) for severe pain. What will the nurse do?
a. Administer the medication as prescribed and initiate a fall risk protocol.
b. Ask for a PRN order for diphenhydramine (Benadryl) for the expected side effect of itching.
c. Request an order for morphine instead of meperidine (Demerol).
d. Suggest to the surgeon that the patient receive diazepam (Valium) to reduce anxiety and the need for narcotics.
ANS: C
In older adults, meperidine is not effective at usual doses and causes more confusion than in younger patients. Morphine is recommended for severe pain. A fall risk protocol is appropriate, but the drug ordered is not. Diphenhydramine is not recommended for older adult patients, because it causes blurred vision. Both diphenhydramine and diazepam have central nervous system (CNS) sedative effects, which will compound the CNS effects of the narcotic. Diazepam also produces prolonged sedation in older adults.
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